Consumption of Low-Calorie Sweeteners among Children and Adults in the United States

doi:10.1016/j.jand.2016.11.004

Journal of the Academy of Nutrition and Dietetics

Volume 117, Issue 3, March 2017, Pages 441-448.e2

https://doi.org/10.1016/j.jand.2016.11.004 Get rights and content

Abstract

Background

Consumption of low-calorie sweeteners (LCSs) has increased markedly during the past several decades, yet the prevalence of LCS consumption in recent years is currently unknown.

Objective

The aim of this study was to describe LCS consumption in the United States and to characterize consumption by sociodemographic subgroups, source, frequency, eating occasion, and location.

Design

Cross-sectional study using National Health and Nutrition Examination Survey data from 2009 to 2012. The prevalence of LCS consumption was assessed using two 24-hour dietary recalls, while the frequency (number of times per day), occasion (meal vs snack vs alone), and location of LCS consumption (at home vs away from home) was assessed using data from the one, in-person, 24-hour dietary recall.

Participants

National Health and Nutrition Examination Survey participants (2 years old or older) either in 2009-2010 (n=9,047) or in 2011-2012 (n=7,939). After excluding participants with implausible energy intake (n=44), the final sample size was 16,942.

Main outcome measures

The primary outcome was the proportion of individuals consuming one or more foods, beverages, or packets containing LCSs during at least one of their two dietary recalls.

Statistical analyses performed

Data were weighted to provide national estimates and Stata frequency procedures for complex survey design were used for all analyses.

Results

Our findings were that 25.1% of children and 41.4% adults reported consuming LCSs. Most LCS consumers reported use once daily (80% of children, 56% of adults) and frequency of consumption increased with body weight in adults. LCS consumption was higher in females compared with males among adults, and in obese individuals, compared with overweight and normal-weight individuals. Individuals of non-Hispanic white race/ethnicity also had higher prevalence of consumption compared with non-Hispanic blacks and Hispanics and those in the highest tertile of income had higher LCS consumption compared with individuals of middle or low income across LCS product categories in adults, and for LCS beverages and LCS foods in children. Most LCS consumers reported consuming LCS with meals (64% of adults, 62% of children) and the majority of LCS consumption occurred at home (71% and 72% among adults and children, respectively).

Conclusions

LCS consumption is highly prevalent in the United States, among both children and adults. Well-controlled, prospective trials are required to understand the health impact of this widespread LCS exposure.

Section snippets

Materials and Methods

This analysis comprised data from two cycles of the NHANES, 2009-2010 and 2011-2012. NHANES is a continuous, cross-sectional study of the US population, with data released in 2-year cycles. NHANES sampling and data collection methods are described elsewhere.¹⁷ All protocols for data collection in NHANES were approved by the Institutional Review Board at the National Center for Health Statistics, and consent/assent was obtained for all participants, as appropriate, before conducting any study

Percentage of General Population Consuming LCSs (Unadjusted Analyses)

Twenty-five percent (25.1%) of children consumed at least one item containing LCSs on at least 1 of the 2 days of recall, and the prevalence of LCS consumption was highest for LCS beverages (19.0%), followed by LCS foods (7.8%). Very few children consumed LCS packets (0.7%), and only 2.1% of children consumed both LCS beverages and LCS foods. Among adults, 41.4% reported consuming LCSs. Thirty-one percent (30.8%) reported consuming LCS beverages, whereas 10.3% and 14.1% reported LCS foods and

Discussion

Our results demonstrate that 25% of children and >41% of adults in the United States consumed LCSs in NHANES 2009-2012. In comparison to previously published data from 1999-2000,¹¹ this represents a 200% increase in consumption in children (8.7% to 25.7%; P<0.0001) and a 54% increase among adults (26.9% to 41.5%; P<0.0001). These estimates are conservative because the analyses are based on dietary recalls, which may be subject to recall bias.²⁶ In addition, analyses do not include children

Conclusions

The current analysis confirms that LCS consumption is highly prevalent in children and adults. Our findings highlight the need to understand the health effects of long-term exposure to LCSs and further emphasize the importance of investigating how and why various sources of LCSs are used in order to understand their potential role in promoting or preventing weight gain and chronic disease. This is of particular relevance for registered dietitian nutritionists and clinicians who may recommend

A. C. Sylvetsky is an assistant professor, Department of Exercise and Nutrition Sciences, and affiliated faculty, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, Washington, DC, and special volunteer, Section on Pediatric Diabetes and Metabolism, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD.

References (39)

C. Fitch et al.
Position of the Academy of Nutrition and Dietetics: Use of nutritive and nonnutritive sweeteners
J Acad Nutr Diet
(2012)
M.Y. Pepino
Metabolic effects of non-nutritive sweeteners
Physiol Behav
(2015)
S.E. Swithers
Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements
Trends Endocrinol Metab
(2013)
D.F. Tate et al.
Replacing caloric beverages with water or diet beverages for weight loss in adults: Main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial
Am J Clin Nutr
(2012)
R.D. Mattes et al.
Nonnutritive sweetener consumption in humans: Effects on appetite and food intake and their putative mechanisms
Am J Clin Nutr
(2009)
A.C. Sylvetsky et al.
Low-calorie sweetener consumption is increasing in the United States
Am J Clin Nutr
(2012)
C. Piernas et al.
Low-calorie- and calorie-sweetened beverages: Diet quality, food intake, and purchase patterns of US household consumers
Am J Clin Nutr
(2014)
K. Murakami et al.
Associations between meal and snack frequency and diet quality in US adults: National Health and Nutrition Examination Survey 2003-2012
J Acad Nutr Diet
(2016)
S. McGuire
Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: US Departments of Agriculture and Health and Human Services, 2015
Adv Nutr
(2016)
US Food and Drug Administration. FDA approves new high-intensity sweetener Advantame....

P.J. Rogers et al.

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies

Int J Obes (Lond)

(2016)

J.C. de Ruyter et al.

A trial of sugar-free or sugar-sweetened beverages and body weight in children

N Engl J Med

(2012)

S.P. Fowler et al.

Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain

Obesity (Silver Spring)

(2008)

S.P. Fowler et al.

Diet soda intake is associated with long-term increases in waist circumference in a biethnic cohort of older adults: The San Antonio Longitudinal Study of Aging

J Am Geriatr Soc

(2015)

A. Drewnowski et al.

Socio-demographic correlates and trends in low-calorie sweetener use among adults in the United States from 1999 to 2008

Eur J Clin Nutr

(2015)

T.H. Fakhouri et al.

Consumption of diet drinks in the United States, 2009-2010

NCHS Data Brief

(2012)

C. Piernas et al.

Trends in purchases and intake of foods and beverages containing caloric and low-calorie sweeteners over the last decade in the United States

Pediatr Obes

(2013)

S.W. Ng et al.

Use of caloric and noncaloric sweeteners in US consumer packaged foods, 2005-2009

J Acad Nutr Diet

(2012)

Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey....

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Y. Jin is a research associate, Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC.

E. J. Clark is a research assistant, Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC.

J. A. Welsh is an assistant professor, Department of Pediatrics, Emory University, Atlanta, GA.

K. I. Rother is chief, Section on Pediatric Diabetes and Metabolism, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD.

S. A. Talegawkar is an associate professor, Department of Exercise and Nutrition Sciences, and affiliated faculty, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, Washington, DC.

: Supplementary materials: Table 3 is available at www.andjrnl.org. Podcast available at www.andjrnl.org/content/podcast

: STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

: FUNDING/SUPPORT This work was supported by the Department of Exercise and Nutrition Sciences at the George Washington University. Additional support was provided by the George Washington University Food Institute Seed Funding. This research was also supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health.

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ResearchOriginal Research: BriefConsumption of Low-Calorie Sweeteners among Children and Adults in the United States

Abstract

Background

Objective

Design

Participants

Main outcome measures

Statistical analyses performed

Results

Conclusions

Section snippets

Materials and Methods

Percentage of General Population Consuming LCSs (Unadjusted Analyses)

Discussion

Conclusions

J Acad Nutr Diet

Physiol Behav

Trends Endocrinol Metab

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

J Acad Nutr Diet

Adv Nutr

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies

Int J Obes (Lond)

A trial of sugar-free or sugar-sweetened beverages and body weight in children

N Engl J Med

Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain

Obesity (Silver Spring)

Diet soda intake is associated with long-term increases in waist circumference in a biethnic cohort of older adults: The San Antonio Longitudinal Study of Aging

J Am Geriatr Soc

Socio-demographic correlates and trends in low-calorie sweetener use among adults in the United States from 1999 to 2008

Eur J Clin Nutr

Consumption of diet drinks in the United States, 2009-2010

NCHS Data Brief

Trends in purchases and intake of foods and beverages containing caloric and low-calorie sweeteners over the last decade in the United States

Pediatr Obes

Use of caloric and noncaloric sweeteners in US consumer packaged foods, 2005-2009

J Acad Nutr Diet

Research
Original Research: Brief
Consumption of Low-Calorie Sweeteners among Children and Adults in the United States